WASHINGTON – The
Obama Administration today has taken a much-needed step to help smokers and
other tobacco users quit by making clear the minimum, evidence-based tobacco
cessation services that health insurers are required to cover under the
Affordable Care Act (ACA).

Today
the Administration posted, in a Frequently Asked Questions format, a clear
statement that tells insurers they must cover, without cost-sharing, screening
for tobacco use and tobacco cessation services for those who use tobacco
products that includes at least two cessation attempts per year. The
Administration stated that coverage should include four tobacco counseling
sessions of at least 10 minutes each (including telephone, group and/or
individual counseling) and all Food and Drug Administration-approved tobacco
cessation medications, including both prescription and over-the-counter (OTC)
medications.

This direction to insurers is an essential step toward fulfilling the promise
of the law to help more tobacco users quit. It establishes a minimum
standard for what insurers must cover and provides tobacco users with an important
tool to help them get the required coverage and treatment. It is critical
that the Department of Health and Human Services and other federal departments
effectively enforce this standard and ensure that insurers provide the
necessary coverage, especially given the evidence that many so far have failed
to do so.

The ACA requires all new private health insurance plans to cover preventive
health services recommended with an A or B grade by the U.S. Preventive
Services Task Force, with no cost-sharing such as co-pays. Tobacco
cessation treatments received an A grade, with the task force finding that a
combination of medication and counseling is most effect at helping tobacco
users quit.

However, evidence indicates that many health plans are not covering the
cessation services that have been proven to help tobacco users quit. Both
this year’s Surgeon General’s report on smoking and a 2012 report by Georgetown
University researchers found that tobacco cessation treatment coverage mandated
by the ACA varies significantly across private health insurance
contracts. The document issued today will help ensure that tobacco users
have evidence-based coverage for cost-free medication and counseling that can
help them quit successfully and that is required by the law.

The new Surgeon General’s report released in January (The Health Consequences of Smoking –
50 Years of Progress) underscored the importance of doing more
to help tobacco users quit. The report found that smoking is even more
hazardous and takes an even greater toll on the nation’s health than previously
reported. It found that smoking annually kills 480,000 Americans –
causing about one in every five deaths – and costs at least $289 billion in
medical bills and other economic losses. As the Surgeon General’s report
notes, in 2011 nearly 70 percent of adult smokers indicated they wanted to stop
smoking and 43 percent had made a quite attempt.

Noting that the "current rate of progress in tobacco control is not fast
enough,” the report calls for a number of specific actions, including
"fulfilling the opportunity of the Affordable Care Act to provide access to
barrier-free proven tobacco use cessation treatment including counseling and
medication to all smokers.”

A
2012 study conducted for the Campaign for Tobacco-Free Kids by Georgetown
University’s Health Policy Institute found that many health insurance plans
were failing to provide the coverage mandated by the ACA for treatments to help
tobacco users quit. Specifically, researchers found that only four of the 39
private plans analyzed clearly covered a full-range of evidence-based tobacco
cessation services (i.e., individual, group and phone counseling and both
prescription and over-the-counter tobacco cessation medications). Contract
language for these plans often contained vague or conflicting language that
made it impossible to determine which, if any, tobacco cessation services were
covered. When the extent of coverage could be determined, many of these plans
excluded coverage of prescription and/or OTC medications for tobacco cessation
and excluded certain types of counseling. Also troubling, some of the plans
analyzed impose cost-sharing requirements for tobacco cessation treatments.

The results of this study prompted the Campaign for Tobacco-Free Kids and other
public health groups to call on federal officials to clarify to insurers that
the full range of cessation services should be covered without cost
sharing. By doing so today, the Administration will help more smokers
quit, saving lives and health care dollars.